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Newark, DE, United States

Mulligan Jr. C.R.,Helen aham Cancer Center | Mulligan Jr. C.R.,Alan arson Regional Cancer Center
Surgical Oncology Clinics of North America

This article reviews the current management of esophageal cancer, including staging and treatment options, as well as providing support for using multidisciplinary teams to better manage esophageal cancer patients. © 2013 Elsevier Inc. Source

Witt R.L.,Thomas Jefferson University | Iacocca M.,Helen aham Cancer Center
American Journal of Otolaryngology - Head and Neck Medicine and Surgery

The aim of this study was to compare capsule exposure using extracapsular dissection (ECD) with partial superficial parotidectomy (PSP) for pleomorphic adenoma. Purpose: Long-term favorable results for recurrence and facial nerve function have been reported for ECD and PSP for parotid pleomorphic adenoma. Extracapsular dissection is distinguished from PSP in that the facial nerve is dissected in PSP but not in ECD. This article attempts to answer the following hypothesis: the margin of normal parotid tissue surrounding a parotid pleomorphic adenoma is less for ECD compared with PSP. Material and Methods: This is a retrospective individual case-control study. Twelve consecutive parotidectomy procedures with a final pathology report of pleomorphic adenoma were retrospectively measured for margin (the percent of capsule exposure around the tumor). In 8 highly selected patients, ECD was performed. Four parotid surgical procedures not meeting strict criteria underwent PSP and served as controls. Results: The eight patients with ECD had a mean of 80% (71%-99%) of the capsule exposed. The 4 PSP procedures had 21% (4%-50%) of the capsule exposed (P <.05). Conclusions: Extracapsular dissection results in higher capsule exposure. © 2012 Elsevier Inc. Source

Simonelli L.E.,Helen aham Cancer Center
Delaware medical journal

There is a relative sparsity of research on and resources for individuals with and survivors of gynecologic cancer compared to other cancers. This paper aims to review the current literature related to the challenges this population faces and subsequent support needs. In addition, it discusses future steps that will allow for the highest quality of care for those recovering from gynecologic cancers. Source

Stephen T.L.,Wistar Institute | Rutkowski M.R.,Wistar Institute | Allegrezza M.J.,Wistar Institute | Perales-Puchalt A.,Wistar Institute | And 7 more authors.

Tumor-reactive Tcells become unresponsive in advanced tumors. Here we have characterized a common mechanism of Tcell unresponsiveness in cancer driven by the upregulation of the transcription factor Forkhead box protein P1 (Foxp1), which prevents CD8+ Tcells from proliferating and upregulating Granzyme-B and interferon-γ in response to tumor antigens. Accordingly, Foxp1-deficient lymphocytes induced rejection of incurable tumors and promoted protection against tumor rechallenge. Mechanistically, Foxp1 interacted with the transcription factors Smad2 and Smad3 in preactivated CD8+ Tcells in response to microenvironmental transforming growth factor-β (TGF-β), and was essential for its suppressive activity. Therefore, Smad2 and Smad3-mediated c-Myc repression requires Foxp1 expression in Tcells. Furthermore, Foxp1 directly mediated TGF-β-induced c-Jun transcriptional repression, which abrogated Tcell activity. Our results unveil a fundamental mechanism of Tcell unresponsiveness different from anergy or exhaustion, driven by TGF-β signaling on tumor-associated lymphocytes undergoing Foxp1-dependent transcriptional regulation. © 2014 Elsevier Inc. Source

Heinberg L.J.,Case Western Reserve University | Keating K.,John Carroll University | Simonelli L.,Helen aham Cancer Center
Obesity Surgery

Background: Patients choose to undergo bariatric surgery for a variety of medical and psychosocial reasons. However, the majority of bariatric surgery candidates have unrealistic weight loss goals, and certain subgroups within this population may be more likely to endorse such beliefs. This study examines weight loss expectations in patients undergoing three different weight loss procedures (laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, or laparoscopic sleeve gastrectomy). Methods: Between October 2007 and June 2008, 114 patients (81.6% female) underwent weight loss surgery. At entry into the program, patients identified their postsurgical goal weights. "Realistic" weights were calculated based on patients' presurgical excess weights and expected loss based upon their surgical procedure. Results: Patient [mean preoperative body mass index (BMI)=48.89] weight loss discrepancies were quite variable with "realistic" versus "dream" weight discrepancies ranging from 0.34 to 71.11 kg (M=28.79 kg; SD=13.21 kg). The mean was equivalent to losing 106% (SD=0.15%) of excess body weight. Baseline BMI, female gender, younger age, and Caucasian ethnicity accounted for up to 62% of the variance in discrepancy scores. After controlling for initial BMI, there were no differences in discrepancies based upon type of surgery. Conclusions: Across all three surgery types, women, Caucasians, younger patients, and those with higher initial BMIs were more likely to have unrealistic goals. Informed consent procedures should help patients, particularly those most likely to be unrealistic, understand likely outcomes as part of education on risks and benefits of weight loss surgery. © 2009 Springer Science + Business Media, LLC. Source

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